A question about MFA I have never seen answered adequately

[dsc]

From what I can discern in terms of planned reimbursement rates, hospitals and doctors would be getting what Medicare currently pays or maybe a bit more (say 1.5 times Medicare). In my state, NC, the state health plan (covers teachers and all state employees) tried to get hospitals to accept at first 1.85 times Medicare and eventually got up to 2 times Medicare and 5 hospitals, not five chains of hospitals but 5 hospitals were willing to accept that. The rest were willing to be out of network for 700,000 insured in my state. We are one of only two developed countries with anything like the percent of private hospitals (we are about 50 while most are about 10). So just how do we not see massive closure of hospitals under this? I understand that there was likely some greed involved here but for hospitals to be so dead set against even 2 times Medicare means that at least our insurance was paying quite a bit more. How do we keep hospitals from just closing down?

[AlexSFCA]

1. they may negotiate higher rates?

Pete is absolutely right; keep ACA, add public option which is MFA. For many it would be the most affordable option but not necessarily as good as private insurance plan. All hospital may be required to accept MFA plan at least for certain percentage, e.g. up to 20% or for certain conditions and can’t deny medicare plan for urgent care. There are many ways to do it so the hospitals are on board. We are not fighting against our doctors, nurses snd hospitals; we are fighting against for profit health insurance industry by leveling the field. In some states (CA, WA, HI, etc.), Kaiser has done an amazing job by integrating non-profit health insurance with its hospital network significantly reducing the cost for everyone while attracting the best doctors and nurses.
MFA won’t pass and even if it would, it is likely unconstitutional. I have no reservations to support Warren because it is a good starting point of negotiations. You start with MFA and you’ll get MFA for all who want it. You start with the second, you’re lucky if you can get some price reductions.

[Ohiogal]

2. That's an excellent question.

And, in some large cities, many doctors won’t even accept Medicare patients.

I may be wrong, but didn’t the ACA provide money to hospitals and clinics to keep them open in states that accepted the Medicaid expansion? Which of course has adversely affected states that did not accept the expansion for whatever reason. Maybe some part of MFA could expand on that? Of course I am sure Republicans would fight that tooth and nail.

[George II]

3. There are many unanswered questions, not the least of which is how it will be funded and...

...what is the bottom line cost to everyone?

Right now the funding is based on several things that have to get through the House and Senate, and the "savings" is based on employers increasing the pay of employees by all or part of what they'll save in private insurance. That's a form of "trickle down" that we know doesn't work. Giving employers a break on their expenses does NOT result in it being given back to the workers.

Another thing is where the roughly 2.5 million people who are in the existing healthcare insurance industry are going to work? I haven't seen that addressed by any of the plans that intend on doing away with private insurance companies.

And yet another is who is going to assume the burden of the work that private insurance companies currently do in administrating the existing Federal Medicare system?

Lots of holes, lots of questions, few answers.

[TidalWave46]

4. There will be a massive reshuffling of the deck.

No question about that and also why I like the idea of implementing it over a decade or even just taking the step of a public option first. Hospitals are designed around the system we have today. Under massive change, some won't be able to change to the environment and will go out of business. Others will open up under the new payment model. Medicare payments are not a loser. They just aren't what is needed to feed the current system which has an insatiable appetite for money.

So to answer your question I think the first thing we should do to limit the shock is to have the system phased in. That is a guarantee as M4A isn't even close to passing. Second, I think we should do very little to stop hospital closures outside of supporting them in smaller communities.

[dansolo]

5. This is why I don't believe the M4A cost estimates

I am in favor of having something like the current Medicare fee schedule for all providers, but I don't believe that using the current fee schedule (Sanders) or a reduced fee schedule (Warren) is at all realistic. Remember, the currently proposed legislation does not control what the fee schedule is, only that it is used. Higher rates will mean higher costs. Medicare rates can be lower because providers are effectively subsidized by non-medicare patients. This also ignores the fact that with an increased tax burden, the costs for providing services will go up, which at a minimum should be incorporated in to the fee schedule.

[rurallib]

6. This is not total answer to your question, but at least hospitals will be

getting paid something.
Somehow about two years ago I ended up in a meeting that included a couple of local hospital CEOs. One was totally in favor of any type of single payer because as he said "at least we would get something."

He went on to explain that between people with no insurance, people whose insurance refused to pay and delays in insurance payments his hospital teetered on the brink of bankruptcy every month.
He was almost begging for single payer.

That would also give he and his folks some idea what kind of a steady income they could anticipate.